Clinical Billing Specialist
4 days ago
The Clinical Billing Specialist is responsible for managing the day-to-day clerical and accounting functions for patient billings, including coding, sending invoices to collect payment from patients and their insurers, and maintaining third-party billing records. This role requires collaboration with the billing team and Customer Service Representatives to ensure a successful revenue cycle.
Key Responsibilities- Post charges for all providers (medical, dental, behavioral health) and ensure they are posted to the highest level of specificity with appropriate modifiers, place of service codes, CPT codes, etc.
- Send all claims to insurance or third-party payers and work the edits and rejections to ensure they are received by the payer.
- Post payments both insurance/third-party and patient/self-pay accurately, as per explanation of benefits, 835 files or statements received, and reconciling back to bank statements to ensure the payment has been received.
- Work denied claims and send appeals to ensure we are capturing revenue as per insurance/payment policies.
- Perform claim follow-up to ensure payers are processing timely and accounts receivable is within normal range, as per performance indicators for clinics of this stature.
- Conduct charge reconciliation at month-end to ensure all charges/encounters are captured for the month to ensure a clean month-end.
- Perform payment audits to ensure accurate payment rates, as per our payer contracts, as well as reviewing charges to ensure rates are set correctly relative to payments.
- Answer phone calls from patients regarding billing, statement, or insurance questions and work with patients to ensure their needs are met.
- Collect delinquent accounts by establishing payment arrangements with patients, monitoring payments, and following up with patients when payment lapses occur.
- Process statements and review for accuracy.
- Identify/verify patient's insurance coverage or other sources of payment and work closely with CSR staff.
- Perform other duties as assigned.
Duties 1 through 11 are designated as ADA Essential Functions and must be performed in this job. All other job duties are secondary functions.
Requirements- Ability to efficiently carry out Midtown Health Center's mission statement and comply with its policies and procedures.
- Ability to establish and maintain effective working relationships with patients, co-workers, and the public and to be able to demonstrate cultural awareness and sensitivity.
- Must be able to maintain strict confidentiality of sensitive information in accordance with HIPAA regulations.
- Ability to comply with all occupational safety and health standards and all rules, regulations, and orders issued under the Occupational Safety and Health Act (OSHA).
- Ability to utilize critical thinking and problem-solving skills to address clinic needs.
- Ability to interpret oral and written instructions and do appropriate follow-up.
- Ability to work independently and as a team member.
- Must have exceptional time management and organizational skills.
- Ability to constructively participate in quality improvement efforts.
- Bilingual (English/Spanish) verbal and written skills highly desired.
- Proficient in Microsoft Office applications and data base application.
- Ability to operate standard office equipment, including but not limited to computers, printers, copiers, scanner, calculators, facsimile machines, and telephone systems.
- Ability to run a multi-line telephone system.
- Must have a general knowledge of medical terms.
- Solid understanding of billing software and electronic medical records system.
- Must understand the differences between and among self-pay patients, insurance patients, Medicare patients, workers' compensation patients, and occupational medicine patients.
- Must have excellent customer service skills, including de-escalation.
- Must have strong oral and written communication skills.
- High School diploma or equivalent required.
- Medical Billing degree/certificate preferred.
- Appropriate experience may be substituted for minimum education requirement.
- 1-2 years of Medical Billing Experience preferred.
- Experience with HMOs, PPOs, Medicare, and Medicaid preferred.
- Must have a valid driver's license and the ability to utilize own transportation for work purposes.
- Maintain physical condition appropriate to the performance of assigned duties and responsibilities, which may include sitting or standing for extended periods of time.
- Strength, movement, auditory, taste/smell, and vision demands specific to job.
- Ability to work varied and extended hour scheduling as requested, including early mornings, evenings, and occasional weekends.
- Ability to work in a smoke-free and drug-free work environment.
This job description is not designed to cover or contain a comprehensive listing of duties or responsibilities that are required of the employee for this job. Duties and responsibilities may change at any time with or without notice.
EEO Statement: Midtown Health Center is an equal opportunity employer and will consider all qualified candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or because he or she is a protected veteran.
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